Part 156 - Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges  


Subpart A - General Provisions
§ 156.10 - Basis and scope.
§ 156.20 - Definitions.
§ 156.50 - Financial support.
§ 156.80 - Single risk pool.
Subpart B - Essential Health Benefits Package
§ 156.100 - State selection of benchmark plan for plan years beginning prior to January 1, 2020.
§ 156.105 - Determination of EHB for multi-state plans.
§ 156.110 - EHB-benchmark plan standards.
§ 156.111 - State selection of EHB-benchmark plan for plan years beginning on or after January 1, 2020.
§ 156.115 - Provision of EHB.
§ 156.120 - Collection of data to define essential health benefits.
§ 156.122 - Prescription drug benefits.
§ 156.125 - Prohibition on discrimination.
§ 156.130 - Cost-sharing requirements.
§ 156.135 - AV calculation for determining level of coverage.
§ 156.140 - Levels of coverage.
§ 156.145 - Determination of minimum value.
§ 156.150 - Application to stand-alone dental plans inside the Exchange.
§ 156.155 - Enrollment in catastrophic plans.
Subpart C - Qualified Health Plan Minimum Certification Standards
§ 156.200 - QHP issuer participation standards.
§ 156.201 - Standardized plan options.
§ 156.202 - Non-standardized plan option limits.
§ 156.210 - QHP rate and benefit information.
§ 156.215 - Advance payments of the premium tax credit and cost-sharing reduction standards.
§ 156.220 - Transparency in coverage.
§ 156.221 - Access to and exchange of health data and plan information.
§ 156.222 - Access to and exchange of health data for providers and payers.
§ 156.223 - Prior authorization requirements.
§ 156.225 - Marketing and Benefit Design of QHPs.
§ 156.230 - Network adequacy standards.
§ 156.235 - Essential community providers.
§ 156.245 - Treatment of direct primary care medical homes.
§ 156.250 - Meaningful access to qualified health plan information.
§ 156.255 - Rating variations.
§ 156.260 - Enrollment periods for qualified individuals.
§ 156.265 - Enrollment process for qualified individuals.
§ 156.270 - Termination of coverage or enrollment for qualified individuals.
§ 156.272 - Issuer participation for the full plan year.
§ 156.275 - Accreditation of QHP issuers.
§ 156.280 - Segregation of funds for abortion services.
§ 156.285 - Additional standards specific to SHOP for plan years beginning prior to January 1, 2018.
§ 155.286 - xxx
§ 156.286 - Additional standards specific to SHOP for plan years beginning on or after January 1, 2018.
§ 156.290 - Non-certification and decertification of QHPs.
§ 156.295 - Prescription drug distribution and cost reporting by QHP issuers.
§ 156.298 - Meaningful difference standard for Qualified Health Plans in the Federally-facilitated Exchanges.
Subpart D - Standards for Qualified Health Plan Issuers for Specific Types of Exchanges
§ 156.330 - Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.
§ 156.340 - Standards for downstream and delegated entities.
§ 156.350 - Eligibility and enrollment standards for Qualified Health Plan issuers on State-based Exchanges on the Federal platform.
Subpart E - Health Insurance Issuer Responsibilities With Respect to Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions
§ 156.400 - Definitions.
§ 156.410 - Cost-sharing reductions for enrollees.
§ 156.420 - Plan variations.
§ 156.425 - Changes in eligibility for cost-sharing reductions.
§ 156.430 - Payment for cost-sharing reductions.
§ 156.440 - Plans eligible for advance payments of the premium tax credit and cost-sharing reductions.
§ 156.460 - Reduction of enrollee's share of premium to account for advance payments of the premium tax credit.
§ 156.470 - Allocation of rates for advance payments of the premium tax credit.
§ 156.480 - Oversight of the administration of the advance payments of the premium tax credit, cost-sharing reductions, and user fee programs.
Subpart F - Consumer Operated and Oriented Plan Program
§ 156.500 - Basis and scope.
§ 156.505 - Definitions.
§ 156.510 - Eligibility.
§ 156.515 - CO-OP standards.
§ 156.520 - Loan terms.
Subpart G - Minimum Essential Coverage
§ 156.600 - The definition of minimum essential coverage.
§ 156.602 - Other coverage that qualifies as minimum essential coverage.
§ 156.604 - Requirements for recognition as minimum essential coverage for types of coverage not otherwise designated minimum essential coverage in the statute or this subpart.
§ 156.606 - HHS audit authority.
Subpart H - Oversight and Financial Integrity Standards for Issuers of Qualified Health Plans in Federally-Facilitated Exchanges
§ 156.705 - Maintenance of records for Federally-facilitated Exchanges.
§ 156.715 - Compliance reviews of QHP issuers in Federally-facilitated Exchanges.
Subpart I - Enforcement Remedies in the Exchanges
§ 156.800 - Available remedies; Scope.
§ 156.805 - Bases and process for imposing civil money penalties in Federally-facilitated Exchanges.
§ 156.806 - Notice of non-compliance.
§ 156.810 - Bases and process for decertification of a QHP offered by an issuer through a Federally-facilitated Exchange.
§ 156.815 - Plan suppression.
Subpart J - Administrative Review of QHP Issuer Sanctions
§ 156.901 - Definitions.
§ 156.903 - Scope of Administrative Law Judge's (ALJ) authority.
§ 156.905 - Filing of request for hearing.
§ 156.907 - Form and content of request for hearing.
§ 156.909 - Amendment of notice of assessment or decertification request for hearing.
§ 156.911 - Dismissal of request for hearing.
§ 156.913 - Settlement.
§ 156.915 - Intervention.
§ 156.917 - Issues to be heard and decided by ALJ.
§ 156.919 - Forms of hearing.
§ 156.921 - Appearance of counsel.
§ 156.923 - Communications with the ALJ.
§ 156.925 - Motions.
§ 156.927 - Form and service of submissions.
§ 156.929 - Computation of time and extensions of time.
§ 156.931 - Acknowledgement of request for hearing.
§ 156.935 - Discovery.
§ 156.937 - Submission of briefs and proposed hearing exhibits.
§ 156.939 - Effect of submission of proposed hearing exhibits.
§ 156.941 - Prehearing conferences.
§ 156.943 - Standard of proof.
§ 156.945 - Evidence.
§ 156.947 - The record.
§ 156.951 - Posthearing briefs.
§ 156.953 - ALJ decision.
§ 156.955 - Sanctions.
§ 156.957 - Review by Administrator.
§ 156.959 - Judicial review.
§ 156.961 - Failure to pay assessment.
§ 156.963 - Final order not subject to review.
Subpart K - Cases Forwarded to Qualified Health Plans and Qualified Health Plan Issuers in Federally-facilitated Exchanges
§ 156.1010 - Standards.
Subpart L - Quality Standards
§ 156.1105 - Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP issuers in Exchanges.
§ 156.1110 - Establishment of patient safety standards for QHP issuers.
§ 156.1120 - Quality rating system.
§ 156.1125 - Enrollee satisfaction survey system.
§ 156.1130 - Quality improvement strategy.
Subpart M - Qualified Health Plan Issuer Responsibilities
§ 156.1210 - Dispute submission.
§ 156.1215 - Payment and collections processes.
§ 156.1220 - Administrative appeals.
§ 156.1230 - Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.
§ 156.1240 - Enrollment process for qualified individuals.
§ 156.1250 - Acceptance of certain third party payments.
§ 156.1255 - Renewal and re-enrollment notices.
§ 156.1256 - Other notices.